Wake-Up Call for Action: The Current Situation of Public, Global and One Health Education during Medical School in Times of Globalization and Increasing Health Threats: A review

Main Article Content

Nikolaos Sapoutzis Laura Corazza Marjo Wijnen-Meijer

Abstract

Public, Global, and One Health are individual approaches to health that partly influence each other and all are becoming increasingly important in medical education. ‘’Public Health’’ is an approach to protect and improve health of a population. Nevertheless, most health threats are transcended national boarders, so the “Global Health” approach is becoming increasingly relevant. The holistic approach "One Health" goes even further: in addition to human health, animal health and the environment must also be considered. All these approaches are influenced by globalization, the increasing immigration and the occurrence of pandemics. Accordingly, it is the responsibility of higher education institutes to integrate health approaches in their curriculum to train future physicians to meet the demands of their patients and the population.


This review reflects the current situation of the mentioned approaches in medical education in different countries from which data are available. The research shows that there exists a wide range of Public Health programms, but they are rarely assessed and only a small number of degrees programes is offered for physicians. In contrast to this, Global Health activities during medical education are more reported, and the main providers for Global Health education are medical schools. The necessity to implement One Health topics in medical curriculum is seen by many organizations, but there are just a few publications about the implementation in medical education available.


The main issue in educating health approaches is a missing standard; the dissent of competences, which are relevant to future practical use; the curriculums are oversaturated; and a lack of expertise to the topics. For the future there is a need to implement health approaches into the core curriculum of medical education. Therefore, it is a possibility to integrate the subjects into existing activities and to use didactic concepts, such as clinical rotation, problem-based learning, or case-based learning. In addition, interprofessional work and partnerships between medical and Public Health communities must be improved.


Public, Global, and One Health education requires a structured and comprehensive curriculum that ensures adequate training of medical students in an increasingly globalized world and diversified patient population.

Keywords: public health, global health, one health, medical education

Article Details

How to Cite
SAPOUTZIS, Nikolaos; CORAZZA, Laura; WIJNEN-MEIJER, Marjo. Wake-Up Call for Action: The Current Situation of Public, Global and One Health Education during Medical School in Times of Globalization and Increasing Health Threats: A review. Medical Research Archives, [S.l.], v. 10, n. 11, nov. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3335>. Date accessed: 17 june 2024. doi: https://doi.org/10.18103/mra.v10i11.3335.
Section
Review Articles

References

1. Porter D. The History of Public Health and the Modern State. Brill; 2020.
2. Acheson D. Public Health in England: The Report of the Committee of Inquiry into the Future Development of the Public Health Function. Her Maj.'s Stat. Off; 1988.
3. CDC Foundation. What is Public Health? Published October 9, 2022. Accessed October 10, 2022. https://www.cdcfoundation.org/what-public-health
4. Robert-Koch-Institut. Public Health - Das RKI als nationales Public-Health-Institut. Published October 10, 2022. Accessed October 10, 2022. https://www.rki.de/DE/Content/Institut/Public_Health/Beitrag_Jubilaeumsbuch.html
5. Maeshiro R, Carney JK. Public Health Is Essential: COVID-19's Learnable Moment for Medical Education. Acad Med. 2020;95(12):1799-1801. doi:10.1097/ACM.0000000000003517
6. Holst J. Global Health–Hope oder Hype. GGW–Das Wissenschaftsforum in Gesundheit und Gesellschaft. 2019;19(2):7-15.
7. Battat R, Seidman G, Chadi N, et al. Global health competencies and approaches in medical education: a literature review. BMC Med Educ. 2010;10:94. doi:10.1186/1472-6920-10-94
8. Burke SC, Chaney BH, Kirsten W. International Videoconferencing for Public Health Education. American Journal of Health Education. 2010;41(1):53-59. doi:10.1080/19325037.2010.10599127
9. Koplan JP, Bond TC, Merson MH, et al. Towards a common definition of global health. The Lancet. 2009;373(9679):1993-1995. doi:10.1016/S0140-6736(09)60332-9
10. Houpt ER, Pearson RD, Hall TL. Three domains of competency in global health education: recommendations for all medical students. Acad Med. 2007;82(3):222-225. doi:10.1097/ACM.0b013e3180305c10
11. The Federal Government. Global Health Strategy of the German Federal Government. Responsibility – Innovation – Partnership: Shaping global health together. Accessed October 10, 2022. https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/5_Publikationen/Gesundheit/Broschueren/Global_Health_Strategy.pdf
12. Robert-Koch-Institut. Public Health - Mehr Gesundheit für alle. Published October 10, 2022. Accessed October 10, 2022. https://www.rki.de/DE/Content/Institut/Public_Health/PH_node.html
13. Dragano N, Gerhardus A, Kurth B-M, et al. Public Health – mehr Gesundheit für alle. Gesundheitswesen. 2016;78(11):686-688. doi:10.1055/s-0042-116192
14. Bryant JH. Educating tomorrow's doctors. World health forum 1993 ; 14(3) : 217-230. 1993. Accessed October 10, 2022. https://apps.who.int/iris/handle/10665/49053
15. Boelen C. Medical education reform: the need for global action. Acad Med. 1992;67(11):745-749. doi:10.1097/00001888-199211000-00007
16. Paccaud F, Weihofen A, Nocera S. Public health education in Europe: old and new challenges. Public Health Reviews. 2011;33(1):66-86.
17. Resnick B, Leider JP, Riegelman R. The Landscape of US Undergraduate Public Health Education. Public Health Rep. 2018;133(5):619-628. doi:10.1177/0033354918784911
18. Hill JO, Peters JC. Environmental contributions to the obesity epidemic. Science. 1998;280(5368):1371-1374. doi:10.1126/science.280.5368.1371
19. Gardner DSL, Hosking J, Metcalf BS, Jeffery AN, Voss LD, Wilkin TJ. Contribution of early weight gain to childhood overweight and metabolic health: a longitudinal study (EarlyBird 36). Pediatrics. 2009;123(1):e67-73. doi:10.1542/peds.2008-1292
20. Broad J, Wallace M. Nutrition and public health in medical education in the UK: reflections and next steps. Public Health Nutr. 2018;21(13):2523-2525. doi:10.1017/S1368980018000800
21. Kaffes I, Moser F, Pham M, Oetjen A, Fehling M. Global health education in Germany: an analysis of current capacity, needs and barriers. BMC Med Educ. 2016;16(1):304. doi:10.1186/s12909-016-0814-y
22. Kreitlow A, Steffens S, Jablonka A, Kuhlmann E. Support for global health and pandemic preparedness in medical education in Germany: Students as change agents. The International Journal of Health Planning and Management. 2021;36(S1):112-123. doi:10.1002/hpm.3143
23. Bandyopadhyay S, Thomas HS, Gurung B, et al. Global health education in medical schools (GHEMS): a national, collaborative study of medical curricula. BMC Med Educ. 2020;20(1).
24. Ehn S, Agardh A, Holmer H, Krantz G, Hagander L. Global health education in Swedish medical schools. Scandinavian Journal of Public Health. 2015;43(7):687-693.
25. Drain PK, Primack A, Hunt DD, Fawzi WW, Holmes KK, Gardner P. Global health in medical education: a call for more training and opportunities. Acad Med. 2007;82(3):226-230. doi:10.1097/ACM.0b013e3180305cf9
26. Brewer TF, Saba N, Clair V. From boutique to basic: a call for standardised medical education in global health. Med Educ. 2009;43(10):930-933. doi:10.1111/j.1365-2923.2009.03458.x
27. Zukunftsforum Public Health. Eckpunkte einer Public-Health-Strategie für Deutschland. Published October 10, 2022. Accessed October 10, 2022. http://zukunftsforum-public-health.de/public-health-strategie/
28. Hommes F, Alpers K, Reime B, Rexroth U. Durch attraktive Karrierewege Public Health in Deutschland nachhaltig stärken – Kernforderungen an eine Public-Health-Strategie für Deutschland im Bereich Human Resources. Gesundheitswesen. 2020;82(4):303-305. doi:10.1055/a-1082-0890
29. Al-Shakarchi N, Obolensky L, Walpole S, Hemingway H, Banerjee A. Global health competencies in UK postgraduate medical training: a scoping review and curricular content analysis. BMJ Open. 2019;9(8):e027577. doi:10.1136/bmjopen-2018-027577
30. Bertelsen NS, DallaPiazza M, Hopkins MA, Ogedegbe G. Teaching global health with simulations and case discussions in a medical student selective. Globalization and Health. 2015;11(1):1-8.
31. Miller WC, Corey G, Lallinger GJ, Durack DT. International health and internal medicine residency training: The Duke University experience. The American Journal of Medicine. 1995;99(3):291-297. doi:10.1016/S0002-9343(99)80162-4
32. Ramsey AH, Haq C, Gjerde CL, Rothenberg D. Career influence of an international health experience during medical school. Fam Med. 2004;36(6):412-416.
33. Bissonette R, Route C. The educational effect of clinical rotations in nonindustrialized countries. Family Medicine. 1994;26(4):226-231.
34. Gupta AR, Wells CK, Horwitz RI, Bia FJ, Barry M. The International Health Program: the fifteen-year experience with Yale University's Internal Medicine Residency Program. Am J Trop Med Hyg. 1999;61(6):1019-1023. doi:10.4269/ajtmh.1999.61.1019
35. Thompson MJ, Huntington MK, Hunt DD, Pinsky LE, Brodie JJ. Educational effects of international health electives on U.S. and Canadian medical students and residents: a literature review. Acad Med. 2003;78(3):342-347. doi:10.1097/00001888-200303000-00023
36. Schultz SH, Rousseau S. International health training in family practice residency programs. Family Medicine. 1998;30(1):29-33.
37. Carville S, Mitchell DR. 'It's A Bit Like Star Trek': The Effectiveness of Video Conferencing. Innovations in Education and Training International. 2000;37(1):42-49. doi:10.1080/135580000362070
38. Gruner D, Pottie K, Archibald D, et al. Introducing global health into the undergraduate medical school curriculum using an e-learning program: a mixed method pilot study. BMC Med Educ. 2015;15:142. doi:10.1186/s12909-015-0421-3
39. Ruiz JG, Mintzer MJ, Leipzig RM. The impact of E-learning in medical education. Acad Med. 2006;81(3):207-212. doi:10.1097/00001888-200603000-00002
40. Aulakh A, Tweed S, Moore J, Graham W. Integrating global health with medical education. The clinical teacher. 2017;14(2):119-123.
41. Gurpinar E, Musal B, Aksakoglu G, Ucku R. Comparison of knowledge scores of medical students in problem-based learning and traditional curriculum on public health topics. BMC Med Educ. 2005;5(1):7. doi:10.1186/1472-6920-5-7
42. Fallah PN, Ovsak GG, Kasper J, et al. A longitudinal case-based global health curriculum for the medical student clerkship year. MedEdPORTAL. 2020;16:11038.
43. Bachmann ME, Nielsen MR, Cohen H, et al. Saving rodents, losing primates—Why we need tailored bushmeat management strategies. People and Nature:889-902.
44. Hirschhausen E von. World Health Summit High Level Event: Developing Strategies for Fighting COVID-19 Around the World; 2020. Accessed October 10, 2022. https://www.bmz.de/resource/blob/75180/88359a742d1b40d1f6a13a4598f9a40b/hirschhausen-data.pdf.
45. Doyle, U., Schröder, P., Schönfeld, J. Was ist der One Health-Ansatz und wie ist er umzusetzen? [What is the One Health approach, and how to implement it?]. https://www.umweltbundesamt.de/sites/default/files/medien/4031/publikationen/umid-02-20-one_health.pdf
46. Federal Ministry for Economic Cooperation and Development. One Health - Gesundheit Systematisch Denken; 2020. https://www.bmz.de/resource/blob/51774/2a1c580d9a002f3651595e6f412761b9/smaterialie530-gesundheit-data.pdf.
47. Docherty L, Foley PL. Survey of One Health programs in U.S. medical schools and development of a novel one health elective for medical students. One Health. 2021;12:100231. doi:10.1016/j.onehlt.2021.100231
48. Linder D, Cardamone C, Cash SB, et al. Development, implementation, and evaluation of a novel multidisciplinary one health course for university undergraduates. One Health. 2020;9:100121. doi:10.1016/j.onehlt.2019.100121
49. Togami E, Gardy JL, Hansen GR, et al. Core Competencies in One Health Education: What Are We Missing? NAM Perspectives. 2018;8(6). doi:10.31478/201806a
50. World Health Organization. Joint External Evaluation of IHR Core Capacities of the United States of America: Mission Report, June 2016; 2017; WHO/WHE/CPI/2017.13. https://apps.who.int/iris/handle/10665/254701.
51. Wilkes MS, Conrad PA, Winer JN. One Health-One Education: Medical and Veterinary Inter-Professional Training. J Vet Med Educ. 2019;46(1):14-20. doi:10.3138/jvme.1116-171r
52. Franco, J.R., Vera, A.J., Herron, A., Donsbach, M.E., Valdez, K.R., Bente, D.A., Dacso, M.M. Interprofessional Perspectives for a Virtual One Health Experience. ISOHA Journal International Student One Health Alliance 2022. https://isohaonehealth.files.wordpress.com/2022/04/isoha-journal-issue-2.pdf
53. Angelos JA, Arens AL, Johnson HA, Cadriel JL, Osburn BI. One Health in food safety and security education: Subject matter outline for a curricular framework. One health (Amsterdam, Netherlands):56-65.
54. Ruiz de Castañeda R, Garrison A, Haeberli P, et al. First 'Global Flipped Classroom in One Health': From MOOCs to research on real world challenges. One Health. 2018;5:37-39. doi:10.1016/j.onehlt.2018.02.001
55. Jasani S. Using a one health approach can foster collaboration through transdisciplinary teaching. Med Teach. 2019;41(7):839-841. doi:10.1080/0142159X.2018.1484080
56. Winer JN, Nakagawa K, Conrad PA, Brown L, Wilkes M. Evaluation of medical and veterinary students' attitudes toward a one health interprofessional curricular exercise. J Interprof Care. 2015;29(1):49-54. doi:10.3109/13561820.2014.940039
57. Ribeiro CdS, van de Burgwal LHM, Regeer BJ. Overcoming challenges for designing and implementing the One Health approach: A systematic review of the literature. One Health. 2019;7:100085. doi:10.1016/j.onehlt.2019.100085
58. Rabinowitz PM, Natterson-Horowitz BJ, Kahn LH, Kock R, Pappaioanou M. Incorporating one health into medical education. BMC Med Educ. 2017;17(1):45. doi:10.1186/s12909-017-0883-6
59. Evrony GD. A PIECE OF MY MIND. A Wild Rotation. JAMA. 2016;316(7):713-714. doi:10.1001/jama.2016.4994